Symptoms of Hyperthyroidism
Tiredness, anxiety, nervousness, emotional over sensitivity, restlessness, easy distractibility, compulsive purposefulness, decreased sleep, warm and moist skin, easy falling of hair, weight loss, change in appetite, feeling of warmth, ill–formed stools, changes in menstrual flow, repeated abortions, goiter, enlargement/bulging and reddening of eyes with excess watering, double vision etc. may result from hyperthyroidism in adults. In children, in addition, growth and sexual development as well as school performance may be affected. All complaints need not be present in a given patient. In fact, sometimes, the patient (especially if elderly) may not have any complaint.
Causes of Hyperthyroidism
- The commonest cause of hyperthyroidism is a condition called Graves’ disease (named after a physician), in which the patient has a smooth (i.e., no nodules) goiter and typical eye complaints (see above). The condition is caused by the production in the body of certain substances called antibodies which stimulate the thyroid and cause increase in its size and/or function. In such an individual, antibodies against other body tissues may be produced leading to other disorders.
- Certain drugs and iodine–containing water filters may cause the thyroid to function excessively. It is important to tell us details of all drugs (‘Allopathic’, ayurvedic etc.) that the patient is taking.
- One or more nodules present in the thyroid gland may function excessively and lead to hyperthyroidism.
- Inflammation of the thyroid gland, as after infection or delivery releases thyroid hormones which are already present inside the thyroid into the blood in large quantities and cause complaints described above. It must be stressed that in these situations, the production of thyroid hormones is not increased.
Hyperthyroidism is diagnosed by estimating the blood level of thyroid hormones and TSH. As the levels in blood are extremely minute, accurate and reliable methods of estimation are of utmost importance.
Treatment of Hyperthyroidism
Different causes of hyperthyroidism have different treatment. It is therefore very important to find the cause before starting treatment.
- For treatment of graves disease, there are three treatment options, namely anti–thyroid tablets to be taken by mouth, radioactive iodine (or radio iodine) or surgery.
- For treatment of single or multiple nodules causing hyperthyroidism, radio iodine or surgery are the treatment options.
- For hyperthyroidism caused by drugs, the drug in question is withdrawn if possible.
- For inflammation of thyroid leading to high blood levels of thyroid hormones, treatment is aimed only at providing relief from complaints.
Anti–Thyroid tablets reduce the increased thyroid function so that it is normalized. The tablets are given 2–4 times in a day. The patient usually experience relief from complaints in a couple of weeks after treatment has been started. The dosage is decided by doing thyroid function tests generally at 6–8 week interval. The treatment is generally continued for at least 18–24 months. At the end of this period, one may stop the tablets gradually. As per western data, in about 30% patients, the disease does not recur. However our own experience suggests that cure (remission) takes place in about 5% patients only. In the remaining 95% patients, the disease returns again (relapses), usually free of side–effects. If the patient develops skin rash or fever or sore throat, treatment should be stopped immediately and we must be informed. Please read the drug information slip given to you carefully before you choose this treatment options.
Radioactive Iodine and Precautions
Radioactive iodine or radio iodine or I–131 treatment is used in the treatment of Graves disease as well as treatment of single or multiple thyroid nodules with increased thyroid function. It is a safe, permanent and easily administered treatment, which usually does not require admission to hospital. Iodine is normally utilized by the thyroid hormones. Radioactive iodine is identical to iodine except that it contains radiation. The dose of radio iodine is given as a liquid by mouth and is decided individually on the basis of thyroid gland activity. The activity the thyroid is determined by a test called thyroid uptake. All anti–thyroid tablets which the patient may be taking are stopped at least 7–10 days before the dose is given. The patient should not eat anything for about 2–4 hours after the dose is given.
Intimate skin contact (as hugging, cuddling, sexual intercourse etc.) is prohibited for about 48 hours after the dose is given. For one week after the dose is given, urine must be flushed carefully using excess water as radiation is excreted through the urine in this time period. Accidental contact with drops of urine that may have spilled sideways, either by the patient or anyone else can cause radiation to enter the body and this may be harmful. After the dose is given, the patient usually does not get any complaints. Rarely, vomiting and/or temporary worsening of thyroid complaints may occur. Should this happen, we must be informed at once. The radiation given thus affects the thyroid only and not any other organ or tissue in the body. Radio iodine treatment given in doses, does not lead to increase in cancers, infertility or abnormal babies later in life.
However, radio iodine is harmful to the fetus. It is never given to a women who is shortly planning pregnancy or who is pregnant or breast–feeding. If given to a women of child–bearing age, it is given within ten days from the last period or after proving that the woman is not pregnant. Such a woman should not become pregnant for about 8–10 months after the dose is given. Effective contraception is necessary in this time period. Radio iodine is also not usually given to children. The effect of radio iodine on the thyroid is not seen for about 3–6 months depending on the amount of dose given. Anti–thyroid tablets are hence restarted about 2 weeks after radio iodine is given and continued in gradually decreasing doses till radio iodine effect is seen. If proper precautions are followed, radio iodine is safe and has no side–effects. It must be noted that radio iodine treatment does not usually reduce the size of the enlarged thyroid. Also, some eye complaints may not be relieved and may in severe cases actually worsen. However, over a period of time (which varies depending on the amount of dose given but generally 3–12 months), the thyroid stops functioning leading to permanent deficiency of thyroid hormones.
When this happens, the patient is likely to have one or more of cramps, tingling, swelling, lethargy etc. To make up for thyroid hormone deficiency, the thyroid hormone is given lifelong in tablet form by mouth. Thyroid function needs to be checked once in 8–10 months once the thyroid hormone dose is fixed. Radio iodine is usually a one–time procedure. Very rarely, one dose may not be enough and more than one dose may be required.
Role of Surgery in Hyperthyroidism
With availability of radio iodine treatment, the role of surgery in thyroid disorders is very limited. It is recommended only if the thyroid is very large in size or if radio iodine cannot be given or is refused by the patient in whom anti–thyroid tablets are not helping.